强化生活方式干预对超重或肥胖并患有 2 型糖尿病的成人肾脏疾病的试验内和试验后影响：Look AHEAD 临床试验的二次分析。

IF 3.7 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

BMJ Open Diabetes Research & Care Pub Date : 2024-05-30 DOI:10.1136/bmjdrc-2024-004079

William C Knowler, Haiying Chen, Judy L Bahnson, Steven E Kahn, Cora E Lewis, David M Nathan, Robert G Nelson, Scott J Pilla, John P Bantle

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引用次数: 0

摘要

简介Look AHEAD 随机临床试验报告称，与糖尿病支持和教育（DSE）相比，为期 8 年的强化生活方式干预（ILI）可延缓 45-76 岁 2 型糖尿病和超重/肥胖成人肾病的进展。在此，我们报告了该试验的次要结果--肾病的长期干预后随访情况：我们研究了ILI（n=2570）与DSE（n=2575）对干预期间和干预后随访（中位数为15.6年）期间估计肾小球滤过率（eGFR）下降到2或需要肾脏替代疗法（KRT：透析或肾移植）的影响：在干预期间（HR=0.80，95% CI=0.66至0.98），ILI的eGFR 2发生率较低，但干预后（HR=1.03，0.86至1.23）或总体（HR=0.92，0.80至1.04）的发生率较低。治疗组在 KRT 方面没有明显差异。在预设的亚组分析中，年龄×治疗的交互作用在整个随访期间具有显著性：eGFR 2 为 p=0.001，KRT 为 p=0.01。基线年龄大于 60 岁的 2205 名参与者在干预期间和总体上对肾脏结果都有益处（eGFR 2 的 HR=0.75, 0.62 至 0.90；KRT 的 HR=0.62, 0.43 至 0.91）。干预后的绝对治疗效果更大：在干预期间和干预后，ILI 使 eGFR 2 的发病率分别降低了 0.46 和 0.76 例/100 人-年；KRT 的发病率分别降低了 0.15 和 0.21 例/100 人-年。结论：ILI减少了干预期间和干预后的肾脏疾病进展，使KRT减少了0.15例/100人年和0.21例/100人年：ILI减少了年龄≥60岁人群在积极干预期间和干预后的肾病进展。应考虑使用ILI降低2型糖尿病老年人的肾病发病率。

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Within and post-trial effects of an intensive lifestyle intervention on kidney disease in adults with overweight or obesity and type 2 diabetes mellitus: a secondary analysis of the Look AHEAD clinical trial.

Introduction: The Look AHEAD randomized clinical trial reported that an 8-year intensive lifestyle intervention (ILI) compared with diabetes support and education (DSE) in adults aged 45-76 years with type 2 diabetes and overweight/obesity delayed kidney disease progression. Here, we report long-term post-intervention follow-up for the trial's secondary outcome of kidney disease.

Research design and methods: We examined effects of ILI (n=2570) versus DSE (n=2575) on decline in estimated glomerular filtration rate (eGFR) to <45 mL/min/1.73 m² or need for kidney replacement therapy (KRT: dialysis or kidney transplant) during intervention and post-intervention follow-up (median 15.6 years overall).

Results: Incidence of eGFR <45 mL/min/1.73 m² was lower in ILI during the intervention (HR=0.80, 95% CI=0.66 to 0.98) but not post-intervention (HR=1.03, 0.86 to 1.23) or overall (HR=0.92, 0.80 to 1.04). There were no significant treatment group differences in KRT. In prespecified subgroup analyses, age×treatment interactions were significant over total follow-up: p=0.001 for eGFR <45 mL/min/1.73 m² and p=0.01 for KRT. The 2205 participants aged >60 years at baseline had benefit in both kidney outcomes during intervention and overall (HR=0.75, 0.62 to 0.90 for eGFR <45 mL/min/1.73 m²; HR=0.62, 0.43 to 0.91 for KRT). The absolute treatment effects were greater post-intervention: ILI reduced the rate of eGFR <45 mL/min/1.73 m² by 0.46 and 0.76 cases/100 person-years during and post-intervention, respectively; and reduced KRT by 0.15 and 0.21 cases/100 person-years. The younger participants experienced no such post-intervention benefits.

Conclusions: ILI reduced kidney disease progression during and following the active intervention in persons aged ≥60 years. ILI should be considered for reducing kidney disease incidence in older persons with type 2 diabetes.

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来源期刊

BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

9.30

自引率

2.40%

发文量

123

审稿时长

18 weeks

期刊介绍： BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.